No single antithrombotic treatment regimen is appropriate for all patients with AF and ACS. Available data promote the use of full-dose direct oral anticoagulants (dabigatran 150 mg twice daily or apixaban 5 mg twice daily) or rivaroxaban 15 mg once daily in patients with AF and ACS or percutaneous coronary intervention. For many patients, the use of a direct oral anticoagulant plus a P2Y12 inhibitor early after ACS and/or percutaneous coronary intervention would be most advantageous; in patients who are at high thrombotic risk, a longer course of triple therapy is appropriate.
The use of dual antiplatelet therapy alone does not sufficiently protect patients against stroke; oral anticoagulant monotherapy, either a direct oral anticoagulant or vitamin K antagonist, does not protect patients against new coronary events.
According to the Chronic Coronary Syndromes Clinical Practice Guidelines of the European Society of Cardiology, long-term oral anticoagulant therapy (either with a non–vitamin K antagonist or a vitamin K antagonist) is recommended for patients with AF and a CHA2DS2-VASc score of at least 2 in men and at least 3 in women (CHA2DS2-VASc: Cardiac failure, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74, Sex [female]). European Society of Cardiology guidelines also suggest considering long-term oral anticoagulant therapy in patients with AF and a CHA2DS2-VASc score of 1 in men and 2 in women.
Learn more about the prevention of thrombotic events in patients with ACS.
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Cite this: Sandeep K. Goyal. Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome - Medscape - Mar 10, 2022.